Provider Demographics
NPI:1104107226
Name:FORD, SANDRA JEAN (MSN, RN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEAN
Last Name:FORD
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:403 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3409
Mailing Address - Country:US
Mailing Address - Phone:850-643-2292
Mailing Address - Fax:850-643-2306
Practice Address - Street 1:12832 NW CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-6918
Practice Address - Country:US
Practice Address - Phone:850-643-2292
Practice Address - Fax:850-643-2306
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9365955363LF0000X
ARA03599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily